Provider Demographics
NPI:1669564985
Name:SAUCEDO, REBECCA ANNETTE (NP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANNETTE
Last Name:SAUCEDO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:670 NINTH STREET
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521
Mailing Address - Country:US
Mailing Address - Phone:707-826-8633
Mailing Address - Fax:707-826-8638
Practice Address - Street 1:2412 BUHNE STREET
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501
Practice Address - Country:US
Practice Address - Phone:707-441-1624
Practice Address - Fax:707-441-1253
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2011-12-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CANP6179363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ17784Medicare UPIN